Profile and Outcome of Patients with Acute Cholangitis in a Tertiary Center in South India

Background The mainstay of management of acute cholangitis includes endoscopic or percutaneous biliary drainage and antimicrobial therapy. We aimed to study the profile and outcomes among patients with acute cholangitis who underwent endoscopic biliary drainage at our center. Methods Seve...

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Autores principales:	Prasanth Raghhupatruni, Rajesh Gopalakrishna, Vinodkumar Ankarath, Shine Sadasivan
Formato:	article
Lenguaje:	EN
Publicado:	Thieme Medical and Scientific Publishers Pvt. Ltd. 2021
Materias:	ercp ptbd bacterobilia bile culture Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/8d1345461dc74991aac9cd13a35c5789
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spelling	oai:doaj.org-article:8d1345461dc74991aac9cd13a35c57892021-11-17T23:30:41ZProfile and Outcome of Patients with Acute Cholangitis in a Tertiary Center in South India0976-50420976-505010.1055/s-0041-1739561https://doaj.org/article/8d1345461dc74991aac9cd13a35c57892021-09-01T00:00:00Zhttp://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1739561https://doaj.org/toc/0976-5042https://doaj.org/toc/0976-5050Background The mainstay of management of acute cholangitis includes endoscopic or percutaneous biliary drainage and antimicrobial therapy. We aimed to study the profile and outcomes among patients with acute cholangitis who underwent endoscopic biliary drainage at our center. Methods Seventy consecutive patients with acute cholangitis diagnosed and managed as per the Tokyo Guidelines 2018 for acute cholangitis between June 1, 2018 to December 31, 2019 were prospectively studied. Clinical, etiological and microbial profile, therapy, and patient outcomes were analyzed. Results Choledocholithiasis (54.3%) and benign biliary stricture (28.6%) and malignancy (17.1%) were common etiological factors. Thirteen patients (18.6%) had underlying chronic liver disease. Moderate-to-severe cholangitis was seen in 67.7% of patients with high and very high grade as compared with 54.5% with medium grade of Charlson comorbidity index (CCI) and 41.2% of patients with low grade of CCI. Elevated C-reactive protein, low albumin, and prolonged international normalized ratio were associated with severe cholangitis. Bile culture was positive in 62.9% and blood culture was positive in 15.7% of patients. Bile cultures were predominantly polymicrobial in contrast to blood cultures (53.8 vs. 18%). Escherichia coli was the predominant isolate in blood and bile. Multidrug resistant (MDR) organisms were seen in 79.5% of positive bile cultures. Conclusions A positive blood or bile culture, but not presence of multiple organisms or presence of MDR organisms in bile, was associated with severity of cholangitis. There was no mortality among these patients in-hospital or at 28-days.Prasanth RaghhupatruniRajesh GopalakrishnaVinodkumar AnkarathShine SadasivanThieme Medical and Scientific Publishers Pvt. Ltd.articleercpptbdbacterobiliabile cultureDiseases of the digestive system. GastroenterologyRC799-869ENJournal of Digestive Endoscopy, Vol 12, Iss 03, Pp 127-132 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	ercp ptbd bacterobilia bile culture Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	ercp ptbd bacterobilia bile culture Diseases of the digestive system. Gastroenterology RC799-869 Prasanth Raghhupatruni Rajesh Gopalakrishna Vinodkumar Ankarath Shine Sadasivan Profile and Outcome of Patients with Acute Cholangitis in a Tertiary Center in South India
description	Background The mainstay of management of acute cholangitis includes endoscopic or percutaneous biliary drainage and antimicrobial therapy. We aimed to study the profile and outcomes among patients with acute cholangitis who underwent endoscopic biliary drainage at our center. Methods Seventy consecutive patients with acute cholangitis diagnosed and managed as per the Tokyo Guidelines 2018 for acute cholangitis between June 1, 2018 to December 31, 2019 were prospectively studied. Clinical, etiological and microbial profile, therapy, and patient outcomes were analyzed. Results Choledocholithiasis (54.3%) and benign biliary stricture (28.6%) and malignancy (17.1%) were common etiological factors. Thirteen patients (18.6%) had underlying chronic liver disease. Moderate-to-severe cholangitis was seen in 67.7% of patients with high and very high grade as compared with 54.5% with medium grade of Charlson comorbidity index (CCI) and 41.2% of patients with low grade of CCI. Elevated C-reactive protein, low albumin, and prolonged international normalized ratio were associated with severe cholangitis. Bile culture was positive in 62.9% and blood culture was positive in 15.7% of patients. Bile cultures were predominantly polymicrobial in contrast to blood cultures (53.8 vs. 18%). Escherichia coli was the predominant isolate in blood and bile. Multidrug resistant (MDR) organisms were seen in 79.5% of positive bile cultures. Conclusions A positive blood or bile culture, but not presence of multiple organisms or presence of MDR organisms in bile, was associated with severity of cholangitis. There was no mortality among these patients in-hospital or at 28-days.
format	article
author	Prasanth Raghhupatruni Rajesh Gopalakrishna Vinodkumar Ankarath Shine Sadasivan
author_facet	Prasanth Raghhupatruni Rajesh Gopalakrishna Vinodkumar Ankarath Shine Sadasivan
author_sort	Prasanth Raghhupatruni
title	Profile and Outcome of Patients with Acute Cholangitis in a Tertiary Center in South India
title_short	Profile and Outcome of Patients with Acute Cholangitis in a Tertiary Center in South India
title_full	Profile and Outcome of Patients with Acute Cholangitis in a Tertiary Center in South India
title_fullStr	Profile and Outcome of Patients with Acute Cholangitis in a Tertiary Center in South India
title_full_unstemmed	Profile and Outcome of Patients with Acute Cholangitis in a Tertiary Center in South India
title_sort	profile and outcome of patients with acute cholangitis in a tertiary center in south india
publisher	Thieme Medical and Scientific Publishers Pvt. Ltd.
publishDate	2021
url	https://doaj.org/article/8d1345461dc74991aac9cd13a35c5789
work_keys_str_mv	AT prasanthraghhupatruni profileandoutcomeofpatientswithacutecholangitisinatertiarycenterinsouthindia AT rajeshgopalakrishna profileandoutcomeofpatientswithacutecholangitisinatertiarycenterinsouthindia AT vinodkumarankarath profileandoutcomeofpatientswithacutecholangitisinatertiarycenterinsouthindia AT shinesadasivan profileandoutcomeofpatientswithacutecholangitisinatertiarycenterinsouthindia
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Profile and Outcome of Patients with Acute Cholangitis in a Tertiary Center in South India

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